July 2009

Q. I'm only 44 and I think I'm going thru menopause I havent had a period in almost a year and I know my hormones about two years ago were not what they should be and they said I was in the start of peri menopuase. I do have hot flashes but my main concern is I've been noticing when I have the slightest urge or feel like I have to pee I better go and not think about it too much it's quite annoying is that part of menopause? Or could it be something else? I've never had bladder problems never any infections so I'm a little stumped.

Do you have any ideas?

A. You mention two concerns - that could very well be related somehow - but then again, maybe not.

Going through menopause at only age 44 is about 8 years earlier than average. Do you have any other menopause symptoms? Hot flashes, trouble with sleep, dry vaginal symptoms? Are you taking estrogen? Did you have any GYN or other abdominal surgery? Do you take medications for other medical conditions?

Your frequent urge to go to the bathroom could be as simple as a mild bladder infection or it could be what I describe in the book a condition called "urge incontinence" which has many causes. Have you had a GYN and pelvic exam? A pelvic/kidney ultrasound? A urinalysis and culture? I would suggest that before you assume your symptoms are from menopause and aging, that you first have a complete examination and testing just to be sure all is okay. >/

Q. My doctor recently prescribed Evista for my bone loss. The side effects seem severe for me. I have previously taken Actonel and Fosamax D. but the results were not good. My question is do I take the Evista and deal with the side effects or do I have other options?

A. It would be helpful to know what your T-score is, how old you are, do you have a history of previous fractures and are you at high risk for breast cancer because of a strong family history?

I do not normally prescribe Evista unless a woman has a high risk of breast cancer and wants to minimize the risk of fractures as well. We simply do not have many many years of research on giving Evista to healthy women although the research so far does show there are a number of benefits along with side effects and concerns.

If you have recurrent fractures and/or severe osteoporosis, the bisphosphanates along with lots of vitamin D and calcium, exercise, remain the most powerful treatments to prevent fractures even if your bone density test does not show great improvement or change.

Q. Apparently, the upstate NY medical society has some major learning to do about Lyme. Dr. Cameron diagnosed my daughter on Sept 8th of this year. But not before she was put through hell by our local doctors and hospitals. We pretty much traced this back to 2007. The doctors here kept treating the "symptoms" she was having, but she kept getting progressively worse and worse. She started having pains in her lower right quad. Eventually, in February of this year, they removed her appendix, although there was nothing really wrong with it. Then the pain moved to her gall bladder, and again, there's nothing wrong with it and I wasn't going to have them remove it.

In the middle of August, she became semi-paralyzed. She couldn't feel her legs and couldn't walk. I again took her to the ER, and the final diagnosis was pretty much (these are my words, not theirs) take 2 aspirins and call a psychiatrist. I was the one that said "screw the medical field" and came home from the hospital and rented her a wheel chair. Then she began having seizures. Final diagnosis? The same thing. This past Monday, she had a total of 7 seizures. The "best neurological team in the area" said it's not epilepsy so there's nothing they can do.

I saw a different neurologist yesterday who upped her dosage of topromax. We are hoping that will calm down the seizures. This doctor has worked with a few Lyme patients but admittedly stated he didn't know a lot about it. That's when I handed him Dr Cameron's business card.

We were actually told by one ER doctor that Chronic Lyme was disproved and it doesn't exist. I asked who proved it, she replied "they". I asked who is "they". I'm still waiting for that answer. She also stated I was "wasting my money" on this "so called expert".

Dr Cameron has been totally awesome in following up with me and how she's doing. He was the one that said neurology needed to be involved and if I can't find one up here, then head to Manhattan. Which I would have no problem doing. I think the hardest part in this area is the hold that AMC has on pediatric patients. No one will touch a child here. I was very lucky to find the neurologist that I saw yesterday. And he only saw her because she just turned 15, he will deal with adolescent but not pediatric.

The up-side to all of this, is that she is actually walking now, although still having some trouble with her feet. Her hearing has come back some, vision is getting better. I just don't understand how living in Upstate NY, the Adirondack Mountain area, the doctors here aren't more familiar with the signs. You don't have to have the rash, my daughter never did.

I just wanted to share my experience with this.

A. Your story is heartbreaking - thank you for sharing. I did not have the rash either but was fortunate enough to suspect it when my neck became stiff and I feared I was developing meningitis.

Thank you again for sharing this with me.

Q. I have watched Dr. Savard on Good Morning America regularly and hope she can help me understand HRT.

I am 55 yrs of age, very healthy, and exhausted from researching my options. Each gynecologist I have seen over the past several years has had a different opinion. Lately one doctor suggested Evamist transdermal spray which seemed to help my hot flashes, but this cost approx. $100 per month. I spoke with the pharmacist at length to find an option, but all the transdermals are fairly new, no generics, none affordable. The doctor suggested the daily use of this spray along with using Prometrium capsules at a rate of 1 per day for 5 days every 6 months. I was thrilled, at first, because a former doctor had me taking estrogen daily and progesterone on day 1-12 of each month. Of course this caused me to menstruate. My new doctor said this was archaic and bad for me and that menopausal women should not be forced to menstruate (for several reasons). Now that I cannot afford the Evamist and this doctor does not approve the use of oral estrogen (which is the only affordable estrogen I have found), I do not know what to do.

I want to know if it is safe to take the Estradiol daily and then the Prometrium every 6 months as mentioned above or if there are other options. I was told there are several health benefits to taking estrogen since I am very healthy. It seems to help my skin not to sag too. Right now I am taking ½ of a 1 mg Estradiol. Until last month I was taking the entire 1 mg pill but I am fearful of taking it when I am only using the Prometrium for five days every 6 months. Hot flashes were severely interfering with my sleep and I want the other benefits of the estrogen such as lower risk of ovarian cancer.

In your opinion, are the added health benefits of estrogen so minimal that they should not be considered. Perhaps I should just suffer from the hot flashes if I cannot afford the Evamist.

A. I appreciate your frustration and confusion. You are not alone. I spend an entire chapter in my most recent book, Ask Dr Marie: Straight Talk and Reassuring Answers to Your Most Private Questions, on the subject. I have just written a newsletter that answers many of your questions as well which will be posted on my website on Monday. We will sign you up for a newsletter!!

Healthy women who are suffering from hot flashes, sleep disturbance, etc. do benefit from taking hormones and I believe the research is reassuring that for younger women such as your self, the risks are minimal compared to the benefits. I do prefer the transdermal route (Evamist may be the mostly costly as it is new; I use Vivelle dot but I know that too is expensive) because it bypasses the liver. However women have safely taken oral estrogen for over 60 years and I understand cost is a big issue. If you have no history of blood clots or high blood pressure, I would consider taking oral estrogen too if I was in your circumstance. You also need to take Prometreium - and the dose and length of time depends on how much estrogen build up you have in your uterus and the dose. The usual recommendation is to take the Prometrium 1-12 days first of each month (or perhaps for 12 days every 3 months if you are on low dose)...I have not heard of using only 5 days every 6 months. For most women that will not be enough progesterone to clean out the uterine lining build-up.

In the end you have to work with your doctor and come up with a plan that works for you.

Q. I know you are bombarded with emails - kind of like I'm bombarded with chemo. Please read this. I'll be as brief as possible. I am a 62 year old female, non-smoker, non-drinker who was diagnosed last Feb. with cholangiocarcinoma (bile-duct cancer). The masses were discovered when looking for possible gall bladder problems (there were none). I had no symptoms and still, after rounds of gemzar and gemzar with cisplatinin, have more symptoms from the chemo than from the cancer:

no jaundice
no weight loss (except when I can't eat due to chemo discomfort) the weight returns
no itching

It is probably too late for me and too early for the new prospects, but, since this cancer is increasing, I would be available as a guinea pig for any trials. However, as a retired music teacher (net retirement for me is app. $440.00 per month) and I don't get medicare or social security, I can't afford to pursue costly trials.

Any suggestions?

A. My heart - and prayers - go out to you. I do not know of any ongoing trials using the Hedgehog Pathway inhibitor drug for cholangiocarcinoma but for any information on clinical trials I would go to www.clinicaltrials.gov where all clinical trials are listed. Does your oncologist have any other advice? Clinical trials usually do not involve a cost to the patient - however I understand you are limited by where you live although Dallas surely has a number of oncology hospitals and ongoing trials.

I guess I am most moved by your courage to not give up and to find a way that you can get the best treatment that you deserve.

Again, my thoughts and prayers are with you.

Q. I recently had some blood work done for hormone testing.

I am scheduled to meet with this doctor the end of the month for the results.(I have not met with her before) I called and asked if I could find out the results before hand so that if the results are normal, the appointment seems unnecessary.

The person I spoke with said that it is illegal for her to directly give me the information. That I would need to have one of my other doctors request the information. Does this sound right?

I don't understand why I cannot have the information and have not been able to find anything stating that whether it is or isn't a law.

A. Although it is your right to have a copy of your blood work, most doctors feel responsible for interpreting the results in the context of your symptoms or complaints. If the doctor has not yet evaluated you, she will not really be able to say that testing is normal. Hormone and many other tests can vary depending on the clinical situation and a normal result may not always be normal for you. So yes, you should be able to get a copy, but understandably your doctor wants to evaluate you as well as I presume she ordered the tests believing that she would have this chance?

Best of luck and hope all is well.

Q. I would love to know more about the clinical trials for ovarian cancer pertaining to the Hedgehog Pathway that Genentec is doing. My sister has ovarian cancer and is looking for help. Thanks ever so much!!!!!

A. The research is still in early Phase 1 and Phase 2 trials and although Genentec states they have ongoing trials, I do not know what medical centers are performing them. My advice would be to go to www.clinicaltrials.gov where all clinical trials are listed and see if one is in your area. Does her oncologist have any information? They usually know what trials are in their area - although I can understand if she wants to travel for a second opinion. I would imagine that the trials are not for women with early stage disease and have fairly rigorous entry criteria.

A second approach would be to contact Genentec directly.

My thoughts and prayers are with both of you.